Outcomes after cytoreductive radical prostatectomy for de novo metastatic hormone-sensitive prostate cancer: survival and time to treatment intensification in a retrospective cohort

Abstract Purpose: To evaluate whether cytoreductive radical prostatectomy (CRP) confers benefit beyond contemporary systemic therapy in men with de novo metastatic hormone-sensitive prostate cancer (mHSPC). Methods:Single-center retrospective cohort (2014–2022) comparing CRP plus systemic therapy versus systemic therapy alone. Primary endpoints were overall (OS) and cancer-specific survival (CSS); secondary endpoints were time to treatment intensification (“no-intensification survival”) and post-intensification progression-free survival (PFS). Kaplan–Meier/log-rank and Cox models were used; competing-risk methods estimated subdistribution hazard ratios (sHR) for intensification. Propensity-score matching (1:2; caliper 0.1) tested robustness. Results:Among 164 patients, 58 received CRP and 106 no local therapy; median follow-up was 30.6 months (36.2 among survivors). In the unmatched cohort, 5-year OS was 70.2% with CRP versus 35.4% without (univariable HR 0.24; multivariable HR 0.40; p=0.006), and 5-year CSS was 83.8% versus 49.6% (HR 0.20; pConclusion: CRP integrated with systemic therapy was associated with improved OS/CSS and delayed treatment intensification without affecting outcomes after intensification, supporting CRP as a potential component of multimodal management in selected men; randomized trials are warranted.